RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01053
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20070615

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E2, Aviation Resource Management Apprentice, medically separated for “bipolar disorder not otherwise specified (NOS)” with a disability rating of 10%.

CI CONTENTION:  The CI contends that she was medically separated during the eligibility time frame of the Physical Disability Board of Review.  The complete submission is at Exhibit A. 

SCOPE OF REVIEW:  The panel’s scope of review is defined in DoDI 6040.44.  It is limited to review of disability ratings assigned to those conditions determined by the Physical Evaluation Board (PEB) to be unfitting for continued military service and when specifically requested by the CI, those conditions identified by the PEB, but determined to be not unfitting or non-compensable.  Any conditions outside the panel’s defined scope of review and any contention not requested in this application may remain eligible for future consideration by the Board for Correction of Military Records.  Furthermore, the panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The panel’s assessment of the PEB rating determination is based on review of medical records and all available evidence for application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards to the unfitting medical condition(s) at the time of separation.  The panel has neither the role nor the authority to compensate for post-separation progression or complications of service-connected conditions.  That role and authority is granted by Congress to the Department of Veterans Affairs, operating under a different set of laws.  The panel gives consideration to VA evidence, particularly within 12 months of separation, but only to the extent that it reasonably reflects the severity of the disability at the time of separation.  

RATING COMPARISON:  

SERVICE PEB 20070504	VARD-20140905	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bipolar Disorder	9432	10%	Generalized Anxiety Disorder  with Major Depressive Disorder	9400	50%	20140814	
Adjustment Disorder	Cat III	No VA Placement	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  70%	

ANALYSIS SUMMARY:  

Bipolar Disorder NOS.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI first presented to mental health (MH) in July 2006 upon referral by her primary care manager.  The CI reported that her symptoms started upon arrival at the base in March 2006.  She had problems with her supervisor.  The CI reported that her mind was “running all over the place,” she was sleeping only 2 hours per night, and feeling “sad and jumpy.”  She was prescribed an anti-depressant medication in December which caused the symptoms suggestive of bipolar disorder.  In February 2007, the CI took a combination of pills after a breakup with her boyfriend.  After falling asleep for several hours, she awakened with the reality of what she had done, and asked a friend to call for an ambulance.  The CI was admitted to the inpatient psychiatry unit, but denied her actions as a suicide attempt.  She was started on medications and diagnosed with bipolar disorder.  Her condition improved significantly with medication, however, she was referred to the MEB.

The MEB NARSUM was accomplished on 26 February 2007, 4 months prior to separation.  The CI reported she felt her problems were related to her being young and away from home for the first time.  She noted that on 4 February 2007 while sitting alone in her room, she felt that she wanted all of her problems to go away so she impulsively took pills.  She denied wanting to die then or now.  Since her discharge from the hospital she “feels great and wants to continue in the Air Force.”  The CI reported that after changing job location she felt much better but again feels that her age, being away from home, and the circumstances that seemed to happen all at once at home are what caused her breakdown.  She no longer endorsed symptoms suggestive of bipolar disorder.  The examiner noted that the outpatient treating psychiatrist had indicated the CI has been doing well since her discharge and that she has continued to take psychotropic medications with benefit.  The CI’s supervisor of 3 weeks also indicated that she has performed well on the job, but was temporarily working out of her primary career field.  The examiner also noted that a review of the medical records indicated the CI’s bipolar symptoms were induced by the anti-depressant medication prescribed in December 2006.

The mental status examination (MSE) was normal.  The diagnoses of bipolar disorder NOS and adjustment disorder with mixed anxiety and depressed mood were recorded, and the Global Assessment of Functioning score was assessed on the cusp of mild to moderate symptoms and or impairment.  The psychiatrist recommended retention “with duty stations limited to CONUS for a period of observation on her treatment regimen to determine long term stability.”

An addendum, authored by the same NARSUM psychiatrist, to the NARSUM dated April 2007 (conducted via telephone) 2 months before separation, noted that since the initial NARSUM the CI had increased moodiness and impulsivity.  She had a 7-day hospital admission in late March secondary to her “impulsively taking another person’s credit card to purchase a telephone.”  The CI felt embarrassed and did not confess until about a week later at which time she was admitted to the hospital.  The MSE was unremarkable.  The examiner noted she continued to require medication for mood stability and would likely need to remain on medication for at least a year.

A VA Claim was filed 7 years after separation and beyond the probative-value scope of the panel.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the bipolar disorder at 10%, coded 9432 (bipolar disorder).  The VA record was too remote from separation for the panel’s consideration.  The panel members first agreed that the provision of VASRD§ 4.129 for a “mental disorder that develops in service as a result of a highly stressful event” was not applicable.

The panel next proceeded to the rating recommendation.  The panel considered the two inpatient admissions, both occurring after the stressful events of a break up with a boyfriend and stealing of credit card.  Each were transient periods of mood instability during stressful events.  The panel also considered the normal MSEs evaluated at 4 and 2 months before separation.  The record also demonstrated she had good response to medication, and periods of impulsivity when faced with stress provoking situations.  Panel members concluded, the CI’s condition at separation was most reflective of the 10% level of disability for “occupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress, or; symptoms controlled by continuous medication.”  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded that there was insufficient cause to recommend a change in the PEB adjudication for the bipolar disorder NOS condition.  

Contended PEB Condition:  Adjustment Disorder.  The panel’s main charge is to assess the fairness of the PEB’s determination that the contended condition was not unfitting.  The condition was not profiled and was not judged to fail retention standards.  There was no performance based evidence from the record that this condition significantly interfered with satisfactory duty performance.  Additionally, the adjustment disorder is not a physical disability and is not ratable IAW DoDI 1332.38.  After due deliberation, the panel concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the contended condition and so no additional disability rating is recommended.  

BOARD FINDINGS:  In the matter of the bipolar disorder NOS condition and IAW VASRD §4.130, the panel recommends no change in the PEB adjudication.  In the matter of the contended adjustment disorder with mixed anxiety and depressed mood conditions, the panel recommends no change from the PEB determination as not unfitting.  There were no other conditions within the panel’s scope of review for consideration. The panel, therefore, recommends that there be no modification or re-characterization of the CI’s disability and separation determination.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150609, with attachments
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

SAF/MRB
XXXXXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXXXX:

Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2015-01053.

After careful consideration of your application and treatment records, the Physical Disability Board of Review determined that the rating assigned at the time of final disposition of your disability evaluation system processing was appropriate.  Accordingly, the Board recommended no re-characterization or modification of your separation.

I have carefully reviewed the evidence of record and the recommendation of the Board.  I concur with that finding and their conclusion that re-characterization of your separation is not warranted.  Accordingly, I accept their recommendation that your application be denied.

Sincerely,

XXXXXXXXXXXXXXXXXXXXX
Director
Air Force Review Boards Agency

Attachment:
Record of Proceedings